可能增加腹膜腔内胆结石丢失引起的腹腔内污染模型发病率的因素。

F Agalar, I Sayek, C Agalar, M Cakmakçi, M Hayran, B Kavuklu
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引用次数: 0

摘要

目的:探讨腹腔内胆结石合并大肠杆菌和不合并无菌胆汁对小鼠腹腔并发症发生率的影响。设计:前瞻性随机研究。地点:土耳其教学医院。材料:180只瑞士白化小鼠分为5组,对照组n = 20只,实验组n = 40只。干预措施:A组单纯剖腹手术(对照组);B组,剖腹,腹腔内滴注大肠杆菌4 × 10(6) 0.1 ml;C组:剖腹手术,切除胆结石;D组,开腹,植入胆结石,滴注大肠杆菌4 × 10(6) 0.1 ml;E组,开腹,植入胆结石,滴注大肠杆菌4 × 10(6) 0.1 ml和无菌胆汁0.1 ml。1、2、4、8周后,每组处死四分之一。主要观察指标:腹膜内脓肿、粘连、穿孔、瘘或梗阻。结果:无小鼠死亡。5组粘连分别为3例(15%)、7例(18%)、30例(75%)、25例(63%)、24例(60%)。A、B、C组均无小鼠出现脓肿,而D、E组各有8只小鼠出现脓肿(20%)。D组1只小鼠出现梗阻。Logistic回归分析显示,在腹腔中添加胆结石和大肠杆菌显著增加了脓肿的形成(p < 0.001),而添加胆汁则没有影响。胆结石使粘连率增加了9倍以上(p < 0.001),而大肠杆菌有或没有胆汁则没有影响(p = 0.75)。结论:腹腔内游离胆结石伴或不伴大肠杆菌或无菌胆汁,或两者兼有,均增加小鼠脓肿和粘连的形成率。这些结果表明,在腹腔镜胆囊切除术中,特别是急性胆囊炎患者,应努力追回落入腹膜腔的胆结石。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors that may increase morbidity in a model of intra-abdominal contamination caused by gallstones lost in the peritoneal cavity.

Objective: To assess the effect of intraperitoneal gallstones with and without Escherichia coli and sterile bile on the incidence of intraperitoneal complications in mice.

Design: Prospective randomised study.

Setting: Teaching hospital, Turkey.

Material: 180 Swiss albino mice in five groups, n = 20 in the control group, and n = 40 in each of the experimental groups.

Interventions: Group A laparotomy alone (controls); group B, laparotomy amd intraperitoneal instillation of E. coli 4 x 10(6) 0.1 ml; group C, laparotomy and insertion of sterilised gallstones; group D, laparotomy, insertion of gallstones and instillation of E. coli 4 x 10(6) 0.1 ml; and group E, laparotomy, insertion of gallstones, and instillation of E. coli 4 x 10(6) 0.1 ml and sterile bile 0.1 ml. A quarter of each group was killed after 1, 2, 4, and 8 weeks.

Main outcome measures: Intra-peritoneal abscesses, adhesions, perforations, fistula, or obstruction.

Results: No mice died. Adhesions were found in 3(15%), 7(18%), 30(75%), 25(63%), and 24(60%) in the five groups, respectively. No mice in groups A, B, or C developed an abscess, but 8 did in each of groups D and E (20%). One mouse in group D developed obstruction. Logistic regression showed that abscess formation was significantly increased by the addition of gallstones and E. coli to the peritoneal cavity (p < 0.001) but the addition of bile had no effect. Gallstones increased the rate of adhesions more than nine fold (p < 0.001) but E. coli with or without bile had no effect (p = 0.75).

Conclusions: Free gallstones within the peritoneal cavity with or without E. coli or sterile bile, or both, increased the rate of formation of both abscesses and adhesions in mice. These results suggest that efforts should be made retrieve gallstones that are dropped into the peritoneal cavity during laparoscopic cholecystectomy, particularly in patients with acute cholecystitis.

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